Validity and Reliability of a Pediatric Hematology Oncology Patient Acuity Tool

Abstract

Appropriate use of nursing resources in the pediatric hematology and oncology inpatient settings demands a patient acuity system that is easy to use and accurate, and that objectively measures nursing care needs of a specialized patient population. Structured survey of 13 comprehensive cancer centers and a review of the literature show no valid and reliable acuity tools for this pediatric population. The purpose of this project was to study the validity and reliability of a newly developed pediatric hematology and oncology acuity system designed to quantify patient care needs. A new acuity tool for this pediatric population was developed based on the patient classification tool used at Johns Hopkins Hospital Oncology Center (JHHOC). The levels of care from the JHHOC tool were adopted, with therapeutic indicators modified to reflect nursing diagnoses relevant to the pediatric inpatient. Nursing care hours required for each level of care were also identified. Validity was studied using a content validity index (CVI). Experts from the pediatric unit where the tool would be used were asked whether each therapeutic indicator was assigned to the correct level of care (1 thru 5) based on patient care hours. CVIs for items ranged from .5 to 1.0; the overall CVI for the tool was .93. Interrater reliability was studied using two raters from the unit. Data were collected for 150 patient observations on a 12-bed pediatric hematology and oncology inpatient and short-stay outpatient unit. The resulting Pearson correlation coefficient was r = .97 (P <.001). The resulting tool is nursing diagnoses based, interfaces with standard care plans, is easy to use, requires no calculation, and provides reliable quantification of nursing work load based on pediatric hematology and oncology patients care needs. Data from this acuity tool determine variable nursing hours per patient per day and assist with patient assignments, staffing and scheduling decisions, budgetary processes, establishing productivity, and will ultimately facilitate establishing charges for nursing services to patients. Currently, a quality assurance interrater reliability design audit system is used to maintain and monitor ongoing integrity and accuracy of the classification system. CVI and interrater reliability studies will occur at regular intervals to ensure the validity and reliability of the tool.